Medicare Compliance & Reimbursement

Stay tuned for more enrollment bottlenecks in 2005.

With providers waiting months before they can bill for services they're providing to Medicare patients, will Medicare pay interest when it finally pays those claims?

Probably not, officials from the Centers for Medicare & Medicaid Services told the Aug. 30 Practicing Physicians Advisory Council meeting.

The law requires CMS to pay interest on "clean claims" if the provider receives payment more than 30 days after billing. But if a provider bills late for whatever reason, even enrollment glitches, CMS owes no interest. "We just don't have the authority to do that," said a CMS official.

But the official also said CMS will discuss the issue "in more detail" at the next PPAC meeting. In the meantime, if you're suffering extreme financial hardship due to enrollment problems, you should contact CMS official Allen Gillespie at agillespie@cms.hhs.gov. He'll help steer your application through the process faster.

Once again, officials said they were making progress on the problem, processing 53,000 applications in June compared to 22,000 in February and 37,000 in April. But once again, providers expressed frustration with the molasses pace of the improvements.

CMS said it hoped to have the Internet version of its enrollment system, called PECOS Web, up and running by fall 2005. This site will be interactive, "like Turbo Tax," and guide the provider through the application process. If you submit an incomplete or incorrect application, the site will reject it automatically instead of miring the application in bureaucracy. CMS is still working out issues with access and security.

The bad news is that once there's a Web enrollment process, you'll have to start re-enrolling in Medicare every three years, the Medical Group Management Association noted in comments to PPAC. CMS has been delaying the three-year revalidation requirement until it had an electronic process. So next year, CMS will be sending forms to all physicians in a phased-in process. But many of the details of this process will be left up to the carriers, which could lead to confusion, MGMA said.

Also, the 300,000 physicians who enrolled prior to 1996 and never filled out the 855 form will need to do so, MGMA points out. The Association predicts another huge enrollment bottleneck and more heinous delays if CMS rushes ahead with these proposals. And the American College of Physicians says it makes no sense for CMS to add new requirements when it's still struggling with PECOS problems.